All doses are given and levels drawn appropriately. Level is at steady state

As per nurse, patient is very edematous and urine output is very low. This is reflected by his recent increase in serum creatinine. If patient is volume overloaded, this may also explain his increase in WBC and CBCs.

Vancomycin level is slightly subtherapeutic (target: 15-20mg/L). However, there is a risk of accumulation with AKI